Postmortem skeletal survey practice in pediatric forensic autopsies: a national survey.
ABSTRACT Recommendations for the evaluation of an unexplained death in infancy include a postmortem skeletal survey (PMSS) to exclude skeletal trauma. Objectives of this study were to assess adherence to these recommendations in forensic autopsies in children equal to or less than 36 months of age, and what factors influence the use or nonuse of the PMSS. We surveyed pathologists who were members of the American Academy of Forensic Sciences. The survey included practice characteristics about where, when, and how PMSS were done. Nearly all respondents (99.6%) indicated they performed PMSS at least some of the time; however, almost a third did not use PMSS for all suspected Sudden Infant Death Syndrome (SIDS), abuse, unsafe sleep, or undetermined causes of death. Despite evidence that "babygrams" are inappropriate in a SIDS workup, 30% of pathologists use them preferentially. Despite SIDS being a diagnosis of exclusion that requires a PMSS, almost 10% of pathologists do not order a PMSS. Future research is necessary to reduce barriers to this important component of the pediatric forensic autopsy.
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ABSTRACT: The definition of sudden infant death syndrome (SIDS) originally appeared in 1969 and was modified 2 decades later. During the following 15 years, an enormous amount of additional information has emerged, justifying additional refinement of the definition of SIDS to incorporate epidemiologic features, risk factors, pathologic features, and ancillary test findings. An expert panel of pediatric and forensic pathologists and pediatricians considered these issues and developed a new general definition of SIDS for administrative and vital statistics purposes. The new definition was then stratified to facilitate research into sudden infant death. Another category, defined as unclassified sudden infant deaths, was introduced for cases that do not meet the criteria for a diagnosis of SIDS and for which alternative diagnoses of natural or unnatural conditions were equivocal. It is anticipated that these new definitions will be modified in the future to accommodate new understanding of SIDS and sudden infant death.PEDIATRICS 08/2004; 114(1):234-8. · 4.47 Impact Factor
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ABSTRACT: The purpose of this study was to determine whether postmortem radiography of neonates, infants, and children provides additional information that is not detected at autopsy in cases of unexpected death. Inclusion criteria for 106 consecutive postmortem skeletal surveys (1998-2000) were neonates, infants, and children 2 years old or younger with no preexisting medical condition to account for mortality. Pediatric radiologists interpreted all the radiographic examinations, which consisted of high-detail, collimated anteroposterior radiographs of the appendicular and axial skeleton, lateral radiographs of the axial skeleton, and oblique radiographs of the ribs. Imaging results were compared with those obtained from standard protocol autopsies on all children. Four categories of death were designated: homicide (i.e., abuse, n = 14), accidental (e.g., drowning, n = 28), natural (e.g., acute illness, n = 43), and undetermined (n = 21). The causes of death in the 14 child abuse victims were blunt force injuries to the intracranial (n = 11) and chest and abdominal (n = 1) areas; asphyxia (n = 1); and shaking injury (n = 1). In six (43%) of these 14 patients, radiography detected 26 extremity fractures that had not been detected at autopsy; four (67%) of these six patients had fractures of different ages that involved more than one extremity. All fractures carried a high index of suspicion of abuse. No skeletal injuries were found in cases of accidental, undetermined, and natural deaths. Postmortem radiography provides important additional information regarding the extent and chronicity of extremity trauma that may not be documented at autopsy. This finding supports the routine use of radiography in cases of suspected child abuse. Normal findings on postmortem skeletal radiography may help to distinguish cases of natural, accidental, and undetermined causes of death from those of abuse, aiding in the proper handling of these cases by medical and law enforcement personnel.American Journal of Roentgenology 07/2002; 178(6):1517-21. · 2.90 Impact Factor
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ABSTRACT: Sudden infant death syndrome (SIDS) still accounts for considerable numbers of unexpected infant deaths in many countries. While numerous theories have been advanced to explain these events, it is increasingly clear that this group of infant deaths results from the complex interaction of a variety of heritable and idiosyncratic endogenous factors interacting with exogenous factors. This has been elegantly summarised in the "three hit" or "triple risk" model. Contradictions and lack of consistencies in the literature have arisen from diverse autopsy approaches, variable applications of diagnostic criteria and inconsistent use of definitions. An approach to sudden infant death is outlined with discussion of appropriate tissue sampling, ancillary investigations and the use of controls in research projects. Standardisation of infant death investigations with the application of uniform definitions and protocols will ensure optimal investigation of individual cases and enable international comparisons of trends.Forensic Science International 02/2007; 165(2-3):129-43. · 2.31 Impact Factor